Montvale Commons Accessible - Regan Development Corp

Title *

Property ID

Draft

Bedrooms Desired

Projected Based Rental Assistance – Supportive Housing Unit ONLY

Preliminary Application for Admission
(DO NOT USE APPLICATION IF NO MEMBER OF HOUSEHOLD IS DISABLED)

Applicant Information

Last Name *

First Name *

Middle Initial

Email Address *

Social Security # *

Date of Birth *

Home Telephone

Work Telephone

Mobile Telephone

Home Address

Street Address *

Apartment #

City *

State *

Zip Code *

Mailing Address

(if different)

Street Address

Apartment #

City

State

Zip Code

Prior Address

(if at current address for less than 2 years)

Street Address

Apartment #

City

State

Zip Code

Landlord Name

Landlord Telephone Number

How long did you live at this address?

Additional Occupants:

Occupant 1

Active	First & Last Name *	Relationship *	Date of Birth *	Sex *	Social Security # *

Occupant 2

Active	First & Last Name *	Relation to Applicant *	Date of Birth *	Sex *	Social Security # *

Select any co-applicant, and all others, if any, who will live with you.

Primary Language

Please Answer The Following Questions

Income

	Household Member Name	Source/Type of Income	Source Name and Address	Amount Received Per Month
1
2
3
4
1

List all GROSS income for all household members who will live in your unit. This includes Social Security, Wages, Public Assistance , Pension, Child Support, Alimony, and/or any other income

Assets

	Household Member Name	Source/Type of Income	Source Name and Address	Approximate Value	Interest Rate / Annual Income
1
2
3
4
1

List all assets for all household members who will live in your unit. including home (less mortgage), checking, savings, trusts, cash, stocks, bonds, CDs, Mutual Funds, Money Market Funds, IRAs, Whole Life Insurance, etc.

Ranking Preferences

Disabled *

(Mark Yes if you are currently receiving SSI or SSD benefits from Social Security Administration.)

Yes
No

I (applicant), my spouse, and/or the co-applicant are (Check all that apply):

Reasonable Accommodation

Race / Ethnic / Language Background of Applicant

Application must be signed to be considered complete.

I understand that this is an application for housing at Montvale Commons ONLY. It is not a contract and does not bind either party. I declare that the statements contained in this application are true and correct to the best of my knowledge and that I have not made a false statement, given false information or omitted information in connection with this application. I understand that if am selected for assistance and it is subsequently determined that I withheld or provided false or incomplete information, it is a basis for the rejection of my application, eviction, or termination of assistance and I may be subject to other penalties. I have no objections to inquiries being made for the purpose of verifying the statements made herein. I agree to authorize Montvale Commons LP, Michaels Management – Affordable LLC, Regan Development Corporation or the Housing Authority of Bergen County or their agents to use this copy of my signature as an approval to perform a credit check, orto check employment, assets and former tenancies, in conjuncture with an apartment. All verifications will be sent directly back to those authorized and will be used only for purposes connected with the apartment.

Signature

Signature of Applicant *

Date *

Signature Additional Occupant 1

Signature of Additional Occupant 1 *

Date *

Signature Additional Occupant 2

Signature of Additional Occupant 2 *

Date *

18+

All people 18+ years and over must sign application

Validate Email

APPLICATION

You have already filled out an application for this location.